A commentary on ‘augmented reality self-training system for suturing in open surgery: a randomized controlled trial’ [Int J Surg 102 (2022) 106650]
Authors: Ziwei Li, Yan Shu
Journal: International Journal of Surgery (2023)

Dear Editor, It is of great significance to apply augmented reality technology (AR) to medical teaching and training. The application of AR is conducive to making clinical teaching more intuitive and succinct in endoscopic surgery1. By superimposing virtual information onto the physical world, AR can enhance personal experience during practice2. However, the application of AR technology to suture teaching can also lead to misleading and details missing. It is needed to demonstrate fully the value of AR in clinical training during open-surgery suturing. In an impressive study from the University of Tokyo, the author stated that composite augmented reality can improve medical students’ suturing ability and yield good teaching results. It is a really exciting advancement for medical training. However, some issues in this article may need further interpretation. First, there was a significant difference in the practice time between the video group (22 min 33 s±7 min 5 s) and the AR group (39 min 41 s±9 min 53 s). Students in the AR group take twice as long as the video group in learning and practicing, which may lead to a decrease in the credibility of the comparison results. Second, the evaluation of suture technology involves not only the evaluation of suture results but also the fluency of the operation and the details of the suture process. As video evaluation is only based on participants’ gloved hands and instruments, it is actually difficult to restore the mistakes and wrong posture of trainees during operation. We believe the standardization of the operation, especially the first time, still requires face-to-face guidance from skillful teachers so that common wrong postures and dangerous movements in the process of suturing can be found and corrected immediately3. At last, as the whole process of suture can be seen directly with the naked eye, does the image of AR obstruct the view? Or, does the obstruction raise the risk of needle stick injury? The author states that the use of AR may play a role in accelerating learning, but after removing AR, students may need more time to adapt to the visual field and operation interface without AR guidance. Admittedly, AR technology brings new teaching programs that may be beneficial in guiding students to learn quickly; however, especially in the context of proficiency, the technology cannot replace the clinical demonstration from teachers4. In conclusion, AR as an advanced technique shows great potential for surgery training. However, it may also bring risks by ignoring teach-by-doing. Surgical skills practice still requires patience and guidance from a skillful surgeon, which cannot be altered by AR. Hence, it is crucial that not only AR but also other advanced technologies be considered a teaching tools after a full demonstration. Ethical approval Not applicable. Sources of funding Chongqing Medical Scientific Research Project (Joint project of Chongqing Health Commission and Science and Technology Bureau) (2020FYYX189). Author contribution The original idea of this research was conceived by Ziwei Li, Ziwei Li and Yan Shu participated in writing the first draft. Yan Shu edited the final manuscript. All authors approved the last version of this manuscript. Conflicts of interest disclosure None. Research Registration Unique Identifying Number (UIN) None. Guarantor Yan Shu. Data statement Data sharing is not applicable to this article as no new data were created or analyzed in this study. Ethical approval: not necessary.